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October 25, 2005

Hypoglycemia

Question from Mexico City, Mexico:

My baby son Joshua is 11 months old. When he was eight months, he had convulsions with a normal EEG and TAC. He's been treated with magnesium valproate. The hepatic control test after one month of treatment showed normal values, but he had glucose of 28 mg/dl [1.6 mmol/L]. I was in shock! Now, he is with an endocrinologist and the metabolic test only shows hypoglycemia, with normal screening of insulin, thyroid, suprarenals, pancreas, liver, electrolytes, cortisol, ACTH, and many other blood tests, as well as an ultrasound of the abdominal cavity. The other abnormal result was an x-ray of the left hand, showing a bone age of nearly four months (he's 11). The doctor told us that he had reactive hypoglycemia and that we should control it only with a high complex carbohydrates and fat diet, eating five times a day, lowering simple sugars, monitoring glucose levels, and to have a Glucagon Emergency Kit, just in case. But, we do not know why my baby has hypoglycemia, or whatever this problem is. Will he always have it or just during childhood? Is there another treatment besides dieting? We have been monitoring and dieting for weeks, and still the glucose levels drop too much every day, morning, afternoon and night. Last Thursday, he went down to 19 mg/dl [1.1 mmol/L]. We are desperate and afraid of the consequences of these very low glucose levels and are need another opinion, please.

Answer:

This does sound like hypoglycemia. These very low blood glucose levels are potentially very dangerous, could be associated with convulsions, loss of consciousness, etc. While it sounds like the testing was extensive and complete, reactive hypoglycemia is rather rare in such young children. I would wonder about forms of glycogen storage disease; some of these are difficult to diagnose and would require liver biopsy by specialists. So, I would encourage you to go back to your pediatric endocrinologist and continue to have close collaboration, share the home monitoring results and see what other possibilities may be considered. Another alternative to consider would be to get a second opinion from another pediatric endocrinologist who can review the original data and be sure that nothing has been omitted or overlooked.

SB